Anovulatory cycle

Anovulatory cycle /AC/ is monophasic menstruation, characterized by the absence of ovulation and the stage of development of the corpus luteum, while maintaining the regularity and rhythmicity of the uterine bleeding.

In gynecology, conditions are distinguished that are accompanied by physiological anovulation, most often in the period of preparing the body for menopause and pathological anovulation in case of sterility.

Physiological tests, transvaginal examination with ultrasound are used to diagnose the condition.

What are the symptoms?

Clinically, AN manifests in different ways. The menstrual-like bleeding that occurs with it may not be distinguished from the usual menstruation in terms of its regularity and amount of blood lost.

In hyperesterogenemia, the bleeding is accompanied by a prolonged and abundant release of blood, which is characteristic of menorrhagia.

If untreated, profuse bleeding is very likely to cause anemia.

AN in women of reproductive age is characterized by the inability to get pregnant, as no egg is released to be fertilized, and for this reason women seek help from a specialist.

What are the causes?

In healthy women of reproductive age, a monophasic menstrual cycle occurs relatively rarely in 1-3% and may alternate with ovulatory periods.

Anovulation can be caused, for example, by a change in climate when traveling and arriving in another geographical region.

The most common physiological causes of AN are age-related changes in the female body – sexual maturation and attenuation of reproductive functions /climax/.

As a physiological process, anovulation combined with amenorrhea are characteristic of pregnancy and postpartum lactation.

In the case of resumption of rhythmic bleeding in 40-50% of lactating women, the cycle has a single-phase anovulatory character.

As a pathology requiring treatment, AN is considered by gynecology in infertility or uterine bleeding caused by folliculogenesis disorders, the absence of ovulation and the absence of the luteal phase.

The causes of pathological AN are usually disorders of the hypothalamic-pituitary regulation of the menstrual cycle, as well as ovarian dysfunction.

Disorders of hypothalamic-pituitary regulation are manifested by the insufficient synthesis of follicle-stimulating hormone /FSH/, which leads to the immaturity of a follicle and, accordingly, its inability to burst and trigger ovulation.

Other possible manifestations of this violation may be:

• Decreased levels of luteinizing hormone /LH/;
• Change in the balance of sex hormones;
• And sometimes excessive synthesis and release of prolactin from the pituitary gland;

AN may be associated with:

• inflammation of the ovaries or uterine appendages /adnexitis/;
• disorders of the enzymatic transformation of sex steroids in the ovaries;
• functional changes of the thyroid gland or the cortex of the adrenal glands;
• infections, neuropsychiatric diseases, intoxication;
• avitaminosis or with other disorders of an alimentary nature;

AN is often observed in congenital malformations of the reproductive system, genetic pathologies and in delayed sexual maturation.

Treatment of anovulatory cycle

The main goal of treatment is to stimulate ovulation and suppress excessive proliferation.

Hormonal therapy is carried out in intermittent cycles depending on the degree of estrogen saturation of the body.

For the step-by-step stimulation of a proper menstrual cycle after preliminary abrasion of the endometrium, preparations with a gonadotropic effect are prescribed. 6-8 days before menstruation, an intramuscular injection of a 1% progesterone solution of 1 ml is performed. daily.

Prevention

To prevent monophasic menstruation care should be taken to:

• the health status of adolescent girls;
• their full nutrition;
• a rational mode of mental and physical exercise and rest;
• timely treatment of genital and extragenital pathologies;
• prevention of infections and exposure to toxic chemicals;